本系统综述的目的是收集和综合有关口服促性腺激素释放激素(GnRH)拮抗剂用于治疗与子宫肌瘤相关的出血的证据。
WebofScience,和MEDLINE数据库于2021年3月5日使用相关医学主题词和关键词的组合进行了电子搜索。搜索仅限于英语和人类研究。
仅包括涉及经期出血与子宫肌瘤相关的患者接受不同剂量口服非肽类GnRH拮抗剂加或不加回治疗的随机对照试验。比较口服非肽GnRH拮抗剂与安慰剂以外的治疗的研究也被排除。
共有5项随机试验纳入分析,包括2463名女性。纳入研究的偏倚风险较低。当治疗与安慰剂比较时,抑制出血的前3个治疗方法是elagolix600毫克,400毫克,和200毫克没有添加回来。Elagolix600mg不加回治疗的闭经风险明显高于低剂量的elagolix,不加回和relugolix。在没有补充的治疗中,子宫体积的变化更为明显。所有治疗均与显著改善的生活质量评分相关,肌瘤症状相关和总体健康相关评分.除了高剂量添加的relugolix,所有治疗均显著增加低密度脂蛋白(LDL)水平.再一次,除elagolix200mg不加回治疗外,所有治疗方式均显著增加LDL/HDL比值.对于没有补充治疗的治疗,增加是最高的。
口服GnRH拮抗剂似乎对肌瘤相关出血和改善生活质量有效。短期使用的安全性是可以接受的,但是脂质代谢受到影响。
The aim of this systematic
review is to gather and synthesize evidence regarding the use of oral gonadotrophin-releasing hormone (GnRH) antagonist for the treatment of bleeding associated with uterine myomas.
Web of Science, and MEDLINE databases were searched electronically on March 5, 2021, using combinations of the relevant Medical Subject Headings terms and keywords. The search was restricted to the English language and to human studies.
Only randomized controlled trials involving patients with heavy menstrual bleeding associated with uterine myomas treated with different doses of oral nonpeptide GnRH antagonists with or without add-back therapy were included. Studies comparing oral nonpeptide GnRH antagonists with treatments other than placebo were also excluded.
A total of 5 randomized trials including 2463 women were included in the analyses. Included studies were found to be at low risk of bias. When treatments were compared against placebo, the top 3 treatments for bleeding suppression were elagolix 600 mg, 400 mg, and 200 mg without add-back. Elagolix 600 mg without add-back therapy had a significantly higher risk of amenorrhea than lower doses of elagolix with and without add-back and relugolix as well. Uterine volume changes were more pronounced in therapies without add-back. All treatments were associated with significantly improved quality of life scores, both for myoma symptom-related and overall health-related scores. With the exception of relugolix with high-dose add-back, all treatments significantly increased low-density lipoprotein (LDL) levels. Again, all treatment modalities except for elagolix 200 mg without add-back significantly increased LDL-to-HDL ratio. The increase was highest for treatment without add-back therapy.
Oral GnRH antagonists seem to be effective for myoma-associated bleeding and for improving quality of life. The safety profile is acceptable for short-term use, but lipid metabolism is affected.